Radiological Physics and Technology

, Volume 12, Issue 4, pp 409–416 | Cite as

Additive value of split-bolus single-phase CT scan protocol for preoperative assessment of lung cancer patients referred for video-assisted thoracic surgery

  • Ryo Watanabe
  • Yoshinori FunamaEmail author
  • Takeshi Takaki
  • Seitaro Oda
  • Takeshi Nakaura
  • Seiichi Murakami
  • Takatoshi Aoki


We aimed to assess the additive value of the split-bolus single-phase computed tomography (CT) scan protocol to preoperatively assess patients with lung cancer, who were referred for video-assisted thoracic surgery, when compared to a standard staging CT protocol. We included 160 patients with lung cancer who underwent a split-bolus single-phase CT scan protocol (split-bolus protocol), which can acquire whole-body staging CT and pulmonary artery-vein separation CT angiography (PA–PV CTA) in a single acquisition and 160 patients who underwent whole-body staging CT (standard protocol). We compared the quality of the staging CT images of hepatic parenchyma, portal vein, and hepatic vein between both protocols. We also investigated image quality on PA–PV CTA images in the split-bolus protocol and recorded the number of patients that underwent the 3D PA–PV CTA imaging process. The split-bolus protocol for staging CT images demonstrated a slightly higher enhancement with regard to the hepatic parenchyma (p = 0.007) and hepatic vein (p = 0.006) than the standard protocol. There was no significant difference in the quality of the staging CT images between both protocols (p = 0.067). The mean CT number for the main pulmonary artery and the left atrium for the PA–PV CTA images in the split-bolus protocol were 289.1 HU and 172.8 HU, respectively. Among the images associated with the split-bolus protocol, 98.1% were of appropriate quality for 3D PA–PV CTA imaging. The split-bolus protocol is a dose-efficient protocol to acquire the staging CT and PA–PV CTA images in a single session and provides sufficient image quality for preoperative assessment in patients with lung cancer.


Split-bolus single-phase CT scan protocol Lung cancer Pulmonary artery-vein separation CT angiography Preoperative assessment 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all study participants.


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Copyright information

© Japanese Society of Radiological Technology and Japan Society of Medical Physics 2019

Authors and Affiliations

  • Ryo Watanabe
    • 1
    • 2
  • Yoshinori Funama
    • 4
    Email author
  • Takeshi Takaki
    • 2
  • Seitaro Oda
    • 5
  • Takeshi Nakaura
    • 5
  • Seiichi Murakami
    • 2
  • Takatoshi Aoki
    • 3
  1. 1.Graduate School of Health SciencesKumamoto UniversityKumamotoJapan
  2. 2.Department of RadiologyHospital of the University of Occupational and Environmental HealthFukuokaJapan
  3. 3.Department of RadiologyUniversity of Occupational and Environmental Health School of MedicineFukuokaJapan
  4. 4.Department of Medical Physics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
  5. 5.Department of RadiologyKumamoto University HospitalKumamotoJapan

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